What is aphasia?

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Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write.
Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals. But brain injuries
resulting in aphasia may also arise from head trauma, from brain tumors, or from infections.
Aphasia can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect
mainly a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together
into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some
channels remain accessible for a limited exchange of information.
http://www.aphasia.org/aphasia-definitions/

What is Aphasia?
Aphasia is an acquired communication disorder that impairs a persons ability to process language, but does not
affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience
difficulty reading and writing. The diagnosis of aphasia does NOT imply a person has a mental illness or impairment in
intelligence.

Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people,
these areas are on the left side of the brain. Aphasia usually occurs suddenly, often following a stroke or head injury, but it may
also develop slowly, as the result of a brain tumor or a progressive neurological disease. The disorder impairs the expression
and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders, such as
dysarthria or apraxia of speech, which also result from brain damage.

Aphasia is a communication disorder that affects a persons ability to process and use language.

It is a neurological condition caused by damage to the portions of the brain responsible for language, and it does not affect
intelligence. Because language plays such a central role in our daily lives, aphasia can be very challenging. Individuals with
aphasia may find it difficult to speak, understand speech, and read and write.

The type and severity of aphasia depends on the precise location and extent of the damaged brain tissue. Aphasia can range
from mildwhere a task like retrieving the names of objects is difficultto severewhere any type of communication is
almost impossible.

Can a Person Have Aphasia Without Having a Physical Disability?

Yes, but many people with aphasia also have weakness or paralysis of their right leg and right
arm.When a person acquires aphasia it is usually due to damage on the left side of the brain,
which controls movements on the right side of the body.

How Long Does it Take to Recover from Aphasia?

If the symptoms of aphasia last longer than two or three months after a stroke, a complete
recovery is unlikely. However, it is important to note that some people continue to improve over
a period of years and even decades. Improvement is a slow process that usually involves both
helping the individual and family understand the nature of aphasia and learning compensatory
strategies for communicating.

How Do You Communicate With a Person With Aphasia?

Click here for our Communication Tips

Does Aphasia Affect a Persons Intelligence?

NO. A person with aphasia may have difficulty retrieving words and names, but the persons
intelligence is basically intact. Aphasia is not like Alzheimers disease; for people with aphasia it is
the ability to access ideas and thoughts through language not the ideas and thoughts
themselves- that is disrupted. But because people with aphasia have difficulty communicating, others
often mistakenly assume they are mentally ill or have mental retardation.

http://www.aphasia.org/aphasia-faqs/

Language is much more than words. It involves our ability to recognize and use words and sentences. Much of this capability
resides in the left hemisphere of the brain. When a person has a stroke or other injury that affects the left side of the brain, it
typically disrupts their ability to use language.

Through language, we:

Communicate our inner thoughts, desires, intentions and

motivations.

Understand what others say to us.

Ask questions.

Give commands.

Comment and interchange.

Listen.

Speak.
 Read.

Write.

A stroke that affects the left side of the brain may lead to aphasia, a language impairment that makes it difficult to use
language in those ways. Aphasia can have tragic consequences.

People with aphasia:

May be disrupted in their ability to use language in ordinary circumstances.

May have difficulty communicating in daily activities.

May have difficulty communicating at home, in social situations, or at work.

May feel isolated.

Scientists and clinicians who study how language is stored in the brain have learned that different aspects of language are
located in different parts of the left hemisphere. For example, areas in the back portions allow us to understand words. When a
stroke affects this posterior or back part of the left hemisphere, people can have great difficulty understanding what they hear
or read.

Imagine going to a foreign country and hearing people speaking all around you. You would know they were using words and
sentences. You might even have an elemental knowledge of that language, allowing you to recognize words here and there,
but you would not have command of the language and couldnt follow most conversation. This is what life is like for people with
comprehension problems.

People with comprehension problems:

Know that people are speaking to them.

Can follow some of the melody of sentences realizing if someone is asking a question or expressing anger.

May have great difficulty understanding specific words.

May have great difficulty understanding how words go together to convey a complete thought.

Wernicke's Aphasia (receptive)

People with serious comprehension difficulties have what is called Wernickes aphasia and:

Often say many words that dont make sense.

May fail to realize they are saying the wrong words; for instance, they might call a fork a gleeble.

May string together a series of meaningless words that sound like a sentence but dont make sense.

Have challenges because our dictionary of words is shelved in a similar region of the left hemisphere, near the area
used for understanding words.
Broca's Aphasia (expressive)
When a stroke injures the frontal regions of the left hemisphere, different kinds of language problems can occur. This part of
the brain is important for putting words together to form complete sentences. Injury to the left frontal area can lead to what is
called Brocas aphasia. Survivors with Broca's aphasia:

Can have great difficulty forming complete sentences.

May get out some basic words to get their message across, but leave out words like is or the.

Often say something that doesnt resemble a sentence.

Can have trouble understanding sentences.

Can make mistakes in following directions like left, right, under, and after.

Carbumpboom! This is not a complete sentence, but it certainly expresses an important idea. Sometimes these
individuals will say a word that is close to what they intend, but not the exact word; for example they may say car when they
mean truck.

A speech pathologist friend mentioned to a patient that she was having a bad day. She said, I was bitten by a dog. The
stroke survivor asked, Why did you do that? In this conversation, the patient understood the basic words spoken, but failed to
realize that the words of the sentence and the order of the words were critical to interpreting the correct meaning of the
sentence, that the dog bit the woman and not vice versa.

Global Aphasia
When a stroke affects an extensive portion of the front and back regions of the left hemisphere, the result may be global
aphasia. Survivors with global aphasia:

May have great difficulty in understanding words and sentences.

May have great difficulty in forming words and sentences.

May understand some words.

Get out a few words at a time.

Have severe difficulties that prevent them from effectively communicating.

Remember, when someone has aphasia:

It is important to make the distinction between language and intelligence.

Many people mistakenly think they are not as smart as they used to be.

Their problem is that they cannot use language to communicate what they know.

They can think, they just cant say what they think.

They can remember familiar faces.

 They can get from place to place.

They still have political opinions, for example.

They may still be able to play chess, for instance.

The challenge for all caregivers and health professionals is to provide people with aphasia a means to express what they
know. Through intensive work in rehabilitation, gains can be made to avoid the frustration and isolation that aphasia can
create.

Excerpted from the article "Talking Tough?", Stroke Connection May/June 2004 (Last science update March 2013)

For most, a stroke has a startling and life-altering effect on both the survivor and family members. All involved find themselves
trying to come to terms with changes ranging from physical and sensory loss to loss of speech and language.

For many survivors, this loss or change in speech (dysarthria, apraxia) and language (aphasia) profoundly alters their social
life. Ironically, research has shown that socializing is one of the best ways to maximize stroke recovery. Many experts contend
that socializing should begin right away in the recovery process.

For many people living with aphasia, dysarthria or apraxia, the question then becomes: How can they socialize if they can't
communicate the way they used to?

Here are some tips you can use to begin your recovery:

Educate yourself about aphasia so you can learn a new way to communicate.

Close family members need to be involved so they can understand their loved ones communication needs and begin
to learn ways to facilitate speech and language.

Experiment with strategies that facilitate social interaction during your rehabilitation.

Many stroke survivors with communication challenges compensate by writing or drawing to supplement verbal
expression, or use gestures or a picture communication book, or even a computer communication system.

Family members can facilitate communication with some simple techniques:

Ask yes/no questions.

Paraphrase periodically during conversation.

Modify the length and complexity of conversations.

Use gestures to emphasize important points.

Establish a topic before beginning conversation.

Your environment also can help support successful socialization. Survivors have told us that it is easiest to begin practicing
conversation in a one-on-one situation with someone they are comfortable with and who understands communication
disorders.

In addition:
 Practice conversation in a quiet, distraction-free environment.

As you become more confident, slowly add more conversational partners but continue to limit distractions such as
background noise (music, other talking, TV).

As you become more comfortable in one-to-one or small group interactions, explore less-controlled social situations
with your speech-language pathologist, close friends and family, or other stroke survivors.

Before you attend these gatherings, practice common things discussed in a variety of situations. For example, How
are you? Its been a long time since I've seen you.

Practice a few statements about current events: Did you see the basketball game? or Boy, we are having beautiful
weather!

The more you practice this script, the greater your chances for success.

Family members can prepare written cues, or organize pictures to promote interactions.

Speakeasy's tips for communicating with speech and language limitations in social settings:

Try, try, try to get your point across no matter what anybody says or thinks.

If waiters speak too fast when you go out to dinner, ask them to slow down.

Try one-on-one conversations.

When talking on the phone with a new person, repeat, Im a stroke survivorcan you understand me?

Make a point to go out and interact with people socializing is an important part of recovery.

No matter who tells you that you cant, its always possible to keep recovering!

Remember that the speech and language changes stroke survivors experience can last a lifetime in some form or another. As
life circumstances change, and your speech and language needs evolve, reevaluate what works and what has not worked in
social situations. And continue to expand your horizons.

For more information on aphasia or to find an ASHA-certified speech-language pathologist in your area, call ASHAs Action
Center at 800-638-8255 or visit ASHA on the Web at www.asha.org.

The following is excerpted from the article "Constraint-Induced Language Therapy for Aphasia," Stroke Connection Magazine,
March/April 2006 (Last science update March 2013)

Constraint-induced therapies (CIT) have received a good deal of attention in the popular press recently.

An early researcher, Dr. Edward Taub, examined the notion that much of the long-term disability of stroke survivors resulted
from a learned tendency to avoid using the impaired arm and hand, instead of focusing on compensating by using the
remaining good limb. Taub proposed the term learned non-use to describe this process by which the survivor increasingly
avoids using the impaired limb and is thus unable to capitalize on the value this limb might offer.
Principles of CIT

Based on this theory, Taub developed a set of treatment principles designed to counteract learned non-use and enhance the
underlying residual abilities of the impaired limb. There were three treatment principles:

1. Constraint avoid the compensation, in this case, by tying down the good limb (paw) of the animals he studied;

2. Forced use require use of the impaired limb by placing the animals in circumstances where they needed to use it to
achieve a meaningful goal (for example, acquiring food pellets); and

3. Massed practice require the constraint and forced use every day and all day long.

In the last decade, Dr. Taub and many others have applied these three principles to humans. Results of these experiments
suggest CIT is helpful in some cases. Emerging results of a randomized controlled trial by Dr. Steve Wolf
of Emory University and others endorse the value of this approach at least with regard to arm rehabilitation.

CIT and aphasia

Recently these same CIT principles have been applied to aphasia rehabilitation. In speech therapy, constraintmeans avoiding
the use of compensatory strategies such as gesturing, drawing, writing, etc. Forced use means communicating only by
talking; and massed practice refers to therapy occurring 24 hours per day.

The activities used in applying CIT principles to aphasia rehabilitation dont differ substantially from what might be found in
more traditional treatment approaches. However, what does differ are the demands placed on the speaker in the context of
relevant, communicative exchange.

Preliminary investigations suggest that CIT principles may be effective in aphasia rehabilitation. However, this investigation is
only beginning, and we are not able to say any more about its efficacy than that in some cases it appears to be helpful. Not
only will further study be needed to confirm that CIT is effective with aphasia, these same studies are needed to confirm
its safety. For example, some of the animal work by Dr. Tim Shallart and colleagues suggested that intensive CIT may be
harmful when performed too early after a stroke. Thus the application of CIT to aphasia rehabilitation must be pursued with
both enthusiasm and caution.

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/Com
municationChallenges/Types-of-Aphasia_UCM_310096_Article.jsp#.WAU3DY997IU

http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061

Aphasia

What causes aphasia?

Aphasia is caused by damage to one or more of the language areas of the brain. Most
often, the cause of the brain injury is a stroke. A stroke occurs when a blood clot or a
leaking or burst vessel cuts off blood flow to part of the brain. Brain cells die when they do
not receive their normal supply of blood, which carries oxygen and important nutrients.
Other causes of brain injury are severe blows to the head, brain tumors, gunshot wounds,
brain infections, and progressive neurological disorders, such as Alzheimers disease.
Areas of the brain affected by Broca's and Wernicke's aphasia

What types of aphasia are there?

There are two broad categories of aphasia: fluent and nonfluent, and there are several
types within these groups.

Damage to the temporal lobe of the brain may result in Wernickes aphasia (seefigure),
the most common type of fluent aphasia. People with Wernickes aphasia may speak in
long, complete sentences that have no meaning, adding unnecessary words and even
creating made-up words.

For example, someone with Wernickes aphasia may say, You know that smoodle
pinkered and that I want to get him round and take care of him like you want before.

As a result, it is often difficult to follow what the person is trying to say. People with
Wernickes aphasia are often unaware of their spoken mistakes. Another hallmark of this
type of aphasia is difficulty understanding speech.

The most common type of nonfluent aphasia is Brocas aphasia (see figure). People with
Brocas aphasia have damage that primarily affects the frontal lobe of the brain. They
often have right-sided weakness or paralysis of the arm and leg because the frontal lobe
is also important for motor movements. People with Brocas aphasia may understand
speech and know what they want to say, but they frequently speak in short phrases that
are produced with great effort. They often omit small words, such as is, and and the.

For example, a person with Brocas aphasia may say, Walk dog, meaning, I will take the
dog for a walk, or book book two table, for There are two books on the table. People
with Brocas aphasia typically understand the speech of others fairly well. Because of this,
they are often aware of their difficulties and can become easily frustrated.
Another type of aphasia, global aphasia, results from damage to extensive portions of the
language areas of the brain. Individuals with global aphasia have severe communication
difficulties and may be extremely limited in their ability to speak or comprehend language.
They may be unable to say even a few words or may repeat the same words or phrases
over and over again. They may have trouble understanding even simple words and
sentences.

There are other types of aphasia, each of which results from damage to different language
areas in the brain. Some people may have difficulty repeating words and sentences even
though they understand them and can speak fluently (conduction aphasia). Others may
have difficulty naming objects even though they know what the object is and what it may
be used for (anomic aphasia).

Sometimes, blood flow to the brain is temporarily interrupted and quickly restored. When
this type of injury occurs, which is called a transient ischemic attack, language abilities
may return in a few hours or days.

How is aphasia diagnosed?

Aphasia is usually first recognized by the physician who treats the person for his or her
brain injury. Most individuals will undergo a magnetic resonance imaging (MRI) or
computed tomography (CT) scan to confirm the presence of a brain injury and to identify
its precise location. The physician also typically tests the persons ability to understand
and produce language, such as following commands, answering questions, naming
objects, and carrying on a conversation.

If the physician suspects aphasia, the patient is usually referred to a speech-language

pathologist, who performs a comprehensive examination of the persons communication
abilities. The persons ability to speak, express ideas, converse socially, understand
language, and read and write are all assessed in detail.

How is aphasia treated?

Following a brain injury, tremendous changes occur in the brain, which help it to recover.
As a result, people with aphasia often see dramatic improvements in their language and
communication abilities in the first few months, even without treatment. But in many
cases, some aphasia remains following this initial recovery period. In these instances,
speech-language therapy is used to help patients regain their ability to communicate.

Research has shown that language and communication abilities can continue to improve
for many years and are sometimes accompanied by new activity in brain tissue near the
damaged area. Some of the factors that may influence the amount of improvement
 include the cause of the brain injury, the area of the brain that was damaged and its
extent, and the age and health of the individual.

Aphasia therapy aims to improve a persons ability to communicate by helping him or her
to use remaining language abilities, restore language abilities as much as possible, and
learn other ways of communicating, such as gestures, pictures, or use of electronic
devices. Individual therapy focuses on the specific needs of the person, while group
therapy offers the opportunity to use new communication skills in a small-group setting.

Recent technologies have provided new tools for people with aphasia. Virtual speech
pathologists provide patients with the flexibility and convenience of getting therapy in
their homes through a computer. The use of speech-generating applications on mobile
devices like tablets can also provide an alternative way to communicate for people who
have difficulty using spoken language.

Increasingly, patients with aphasia participate in activities, such as book clubs, technology
groups, and art and drama clubs. Such experiences help patients regain their confidence
and social self-esteem, in addition to improving their communication skills. Stroke clubs,
regional support groups formed by people who have had a stroke, are available in most
major cities. These clubs can help a person and his or her family adjust to the life changes
that accompany stroke and aphasia.

Family involvement is often a crucial component of aphasia treatment because it enables

family members to learn the best way to communicate with their loved one.

Family members are encouraged to:

Participate in therapy sessions, if possible.

Simplify language by using short, uncomplicated sentences.
Repeat the content words or write down key words to clarify meaning as needed.
Maintain a natural conversational manner appropriate for an adult.
Minimize distractions, such as a loud radio or TV, whenever possible.
Include the person with aphasia in conversations.
Ask for and value the opinion of the person with aphasia, especially regarding
family matters.
Encourage any type of communication, whether it is speech, gesture, pointing, or
drawing.
Avoid correcting the persons speech.
Allow the person plenty of time to talk.
 Help the person become involved outside the home. Seek out support groups, such
as stroke clubs.

What research is being done for aphasia?

Researchers are testing new types of speech-language therapy in people with both recent
and chronic aphasia to see if new methods can better help them recover word retrieval,
grammar, prosody (tone), and other aspects of speech.

Some of these new methods involve improving cognitive abilities that support the
processing of language, such as short-term memory and attention. Others involve
activities that stimulate the mental representations of sounds, words, and sentences,
making them easier to access and retrieve.

Researchers are also exploring drug therapy as an experimental approach to treating

aphasia. Some studies are testing whether drugs that affect the chemical
neurotransmitters in the brain can be used in combination with speech-language therapy
to improve recovery of various language functions.

Other research is focused on using advanced imaging methods, such as functional

magnetic resonance imaging (fMRI), to explore how language is processed in the normal
and damaged brain and to understand recovery processes. This type of research may
advance our knowledge of how the areas involved in speech and understanding language
reorganize after a brain injury. The results could have implications for the diagnosis and
treatment of aphasia and other neurological disorders.

A relatively new area of interest in aphasia research is noninvasive brain stimulation in

combination with speech-language therapy. Two such brain stimulation techniques,
transcranial magnetic stimulation (TMS) and transcranial direct current stimulation
(tDCS), temporarily alter normal brain activity in the region being stimulated.

Researchers originally used these techniques to help them understand the parts of the
brain that played a role in language and recovery after a stroke. Recently, scientists are
studying if this temporary alteration of brain activity might help people re-learn language
use. Several clinical trials funded by the National Institute on Deafness and Other
Communication Disorders (NIDCD) are currently testing these technologies.

NIDCD-funded clinical trials are also testing other treatments for aphasia. A list of active
NIDCD-funded aphasia trials can be found at ClinicalTrials.gov.

https://www.nidcd.nih.gov/health/aphasia
Researchers, physicians, and speech-language pathologists have categorized aphasia into six
different types.
Anomic Aphasia

Anomic aphasia is the least severe form. With it, individuals are often unable to
supply the correct words for the things they want to talk aboutobjects, people,
places, or events. Its sometimes described as having a word on the tip of ones
tongue. He or she usually understands speech well and is able to read adequately,
but writing ability may be poor.

Brocas Aphasia

Brocas aphasia is also referred to as nonfluent or expressive aphasia. This type of

aphasia can be very frustrating, as a person with Brocas aphasia knows what he or
she wants to say, but is unable to accurately produce the correct word or sentence.
Expressing language in the form of speech and writing will be severely reduced. The
person may be limited to short telegraphic statements, with words like is or the
left out. People who are diagnosed with severe Brocas aphasia may benefit from an
augmentative and alternative communication (AAC) device.

Mixed Nonfluent Aphasia

Mixed nonfluent aphasia resembles a severe form of Brocas aphasia because the
persons speech is sparse and laborious. However, unlike Brocas aphasia, a person
with mixed nonfluent aphasia may also have limited understanding of speech and
not be able to read or write beyond an elementary level.
Wernickes Aphasia

Persons diagnosed with Wernickes aphasia are unaware that the words they are
producing are incorrect and nonsensical. He or she may have severe
comprehension difficulties and be unable to grasp the meaning of spoken words, yet
may be able to produce fluent and connected speech. Reading and writing are often
severely impaired as well.

Global Aphasia

Global aphasia, as the name suggests, refers to widespread impairment. This is the
most severe form of aphasia and usually occurs immediately after a stroke in
patients who have experienced extensive damage to the brains language area. A
person with global aphasia loses almost all language function and has great
difficulty understanding as well as forming words and sentences. People who are
suffering from global aphasia may only be able to produce a few recognizable
words, understand little or no spoken speech, and be unable to read or write.

Primary Progressive Aphasia

Primary progressive aphasia is a rare degenerative brain and nervous system

disorder that causes speaking and language skills to decline over time. A person
becoming symptomatic with primary progressive aphasia may have trouble naming
objects or may misuse word endings, verb tenses, conjunctions, and pronouns.
Unlike actual aphasia, which is the result of brain damage, primary progressive
aphasia is a progressive type of dementia.

Categorizing different subtypes of aphasia can be complicated.

Aphasia may be classified based on the location of the lesion or the patterns of
language difficulties, each with varying degrees of influence on an individuals
language skills. It is important to keep in mind that a persons initial presenting
symptoms can change with recovery, and, therefore, the classification of the
aphasia may change. Caregivers and loved ones facing an aphasia diagnosis
should check with their speech-language pathologist or neurologist to confirm that
the correct type of aphasia has been identified.

https://www.aphasia.com/about-aphasia/what-is-aphasia/

https://en.wikiversity.org/wiki/Psycholinguistics/Aphasia

Aphasia
What can we learn from research about aphasia?
Research focused on aphasia is important for ensuring that people with aphasia achieve the best possible rehabilitation
outcomes. In addition, learning more about aphasia can generate new knowledge concerning how language is represented in
the brain, the cognitive processes involved with language, and the social organisation of language. At Macquarie, researchers
including Professor Lyndsey Nickels, Professor Linda Cupples, and Dr Britta Biedermann are investigating the cognitive
mechanisms involved in language processing, and related aphasia treatments. Dr Scott Barnes is also investigating aphasia,
but his research focuses on how people with aphasia use language in everyday life, and how this can contribute to aphasia
treatment.

Project: Aphasia and interaction

Aphasia is an acquired language disability typically caused by stroke. It affects the ability to use and understand language,
while other cognitive functions remain largely unaffected. People with aphasia often have significantly difficulty communicating,
but well-targeted treatment can improve their language abilities, and how aphasia affects daily life. In this ongoing research,
interactions involving people with aphasia are being studied to discover more about how people with aphasia use language,
and how having aphasia affects routine social activities. In particular, this research focuses on interactions involving people
with aphasia and their familiar communication partners, and interactions involving people with aphasia and health
professionals. Describing how these interactions are structured - patterns in turn-taking, repair of communication breakdown,
and ordering and construction of social actions - will contribute to the development and refinement of linguistically and socially
focused treatments for aphasia.

Team members: Dr. Scott Barnes, Prof. Alison Ferguson, Dr. Erin Godecke, Laura Cubirka, Sam Maunder, Dayle Sweikert

Project: Conversation therapy for aphasia

This project focuses on improving routine conversations between people with aphasia and their familiar communication
partners, like family and friends. It will explore how people with aphasia, their familiar communication partners, and speech
pathologists work together to address the communication problems that aphasia causes in everyday life. In particular, this
study will examine how the communicative practices used by speech pathologists contribute to therapy outcomes.

Team Members: Dr. Scott Barnes, Prof. Lyndsey Nickels

 Project: Measuring conversations involving people with TBI
People who suffer a traumatic brain injury (TBI) often of have severe difficulty communicating with their friends and family. The
cognitive deficits caused by TBI typically lead to problems with effectively, efficiently, and appropriately communicating, but
these deficits can be difficult to measure. Being able to measure them is important for tracking improvement over time; in
particular, improvement caused by treatment. This project focuses on the use of rating scale measures to capture the effects
of TBI on conversation. It examines the use of rating scales measures by novice raters following an intensive training program.
The findings of this project will contribute to developing better measurement tools for this complex area of clinical work, and
best practice for training in their use.

Team Members: Dr. Scott Barnes, Dr. Emma Power, Prof. Leanne Togher

For more information about aphasia, and aphasia research, please see:

http://www.aphasia.org.au/

http://www.ccreaphasia.org.au/

http://www.mq.edu.au/about_us/faculties_and_departments/faculty_of_human_sciences/lin
guistics/linguistics_research/language_acquisition_and_disorders_of_language/aphasia/

Research topic: Aphasia

Aphasia means difficulties with speaking, reading, writing and/or understanding

Linguistic research into aphasia informs us about language in general. At the same time this research
provides important insights useful to speech and language therapists and others working directly with
people affected by aphasia. This linguistic research can also be used to develop methods of assessing
and treating language difficulties.
https://www.hf.uio.no/iln/english/research/subjects/aphasia/

Linguistics 001 Lecture 18 Brain and Language

Mind and Brain
Over the past century or so, we've learned a lot about the mental processes of producing,
perceiving and learning language. This knowledge is detailed and extensive, but in most cases, we
do not know how these processes are actually implemented in the brain. Over the same period,
we've learned a great deal about the localization of different linguistic abilities in different regions of
the brain, and also about how neural computation works in general. However, our understanding of
how the brain creates and understands language remains relatively crude. One of today's great
scientific challenges is to integrate the results of these two different kinds of investigation -- of the
mind and of the brain -- with the goal of bringing both to a deeper level of understanding.

As a concrete example of this mind/brain dichotomy, consider the following. From literally
thousands of studies, we know that word frequency has a large effect on mental processing of both
speech and text: in all sorts of tasks commoner words are processed more quickly than rarer ones,
other things equal. However, we don't know for sure how this is implemented in the brain. Is "neural
knowledge" of more common words stored in larger or more widespread chunks of brain tissue?
Are the neural representations of common words more widely or strongly connected? Are the
resting activation levels of their neural representations simply higher? Are they less efficiently
inhibited? Amazingly enough, there is no clear evidence about the relative contributions of these
four different different kinds of brain mechanisms to the phenomenon of word frequency effects.

Again, psychological research tells us that there is also a strong recency effect: in all sorts of tasks,
words that we've heard or seen recently are processed more quickly. Again, we don't know how the
recency effect arises in the brain, nor do we know whether the brain mechanisms underlying the
frequency and recency effects are the partly or entirely the same. There is no lack of speculation on
these questions, but we honestly just don't know at this point.

This simple example is typical. Very little of what we know about mental processing of speech and
language can be translated with confidence into talk about the brain. At the same time, very little of
what we know about the neurology of language can now be expressed coherently in terms of what
we know about mental processing of language. For example, one of the most striking facts about
the neurology of speech and language is lateralization: the fact that the one of the two cerebral
hemispheres, usually the left one, plays a dominant role in many aspects of language-related brain
function. However, we learn about this only by probing brain function directly -- looking at the
symptoms of stroke or head trauma, injecting an anesthetic into the right or left internal carotic
artery, imaging cerebral blood flow during the performance of certain language-related tasks, etc.
There is nothing obvious in the behavioral or cognitive exploration of linguistic activity that connects
to its cerebral lateralization (though we'll see later that there are some interestly non-obvious ideas
about this!)
The relation between mind and brain in general is a active "frontier" area of science, in which the
potential for progress is very great. The neural correlates of linguistic activity, and the linguistic
meaning of neural activity, are especially interesting topics. Reports of current research in this area
are often presented at Penn, for example in the meetings of the IRCS/CCN Brain and
Languagegroup.

Functional localization of speech and language

Over the past couple of hundred years, most of what we know about how language is processed in
the brain has come from studies of the functional consequences of localized brain injury, due to
stroke, head trauma or localized degenerative disease. More recently, tools for "functional imaging"
of the brain, such as fMRI, PET, MEG and ERP, provide a new sort of evidence about the
localization of mental processing in undamaged brains. All of these techniques have their
limitations, and so far they have mainly confirmed and refined earlier conceptions rather than
revolutionizing them. However, over the next few decades these techniques promise enormous
strides in understanding how the brain works in general, and in particular how it creates and
understands language.

An excellent and detailed survey for a lay audience of what sorts of processing go on where in the
brain, with some speculation about how and why, can be found in William H. Calvin and George A.
Ojemann's CONVERSATIONS WITH NEIL'S BRAIN . If you are curious (and most people find the
topic fascinating), you should spend some time reading either the on-line version or the published
version of this book.

The taxonomy of language-related neurological problems, or aphasia, has been elaborated over
the past decades. There are many named aphasic syndromes with clear instructions for differential
diagnosis, and a plausible story about how these syndromes are linked to localization of language
functions in the brain, and to injuries to various brain tissues. We'll return shortly to a more
elaborated table of aphasic syndromes, with connections to diagnostic patterns and likely areas of
brain damage, after looking in more detail at the two basic categories of aphasia that were
identified by two 19th-century researchers, Paul Broca and Carl Wernicke.

Broca's Aphasia and Wernicke's Aphasia

As a National Institutes of Health information page says:

Broca's aphasia results from damage to the front portion of the language dominant side of the brain.
Wernicke's aphasia results from damage to the back portion of the language dominant side of the
brain.

Aphasia means "partial or total loss of the ability to articulate ideas... due to brain damage."
A note of caution: functional localization varies, sometimes considerably, across individuals. Brain
injury (most commonly caused by stroke) is usually widespread enough to affect several different
functional areas. Thus each patient is individual both in terms of symptoms and in terms of the
correlation of symptoms to area of damage. Nevertheless, there are broad syndromes of deficit-
associated-with-local-damage, as described succinctly in the NIH passage above, that are
characterized as Broca's and Wernicke's aphasia.

Here is a somewhat more precise picture of the typical placement of Broca's area and Wernicke's
area relative to various landmarks of cortical anatomy and physiology:

Broca's aphasia is sometimes called disfluent aphasia or agrammatic aphasia. It is named after
Pierre-Paul Broca (1824-1880), a French surgeon and anthropologist who first described the
syndrome and its association with injuries to a specific region of the brain.

Agrammatism typically involves laboured speech, and a lack of use of syntax in speech production
and comprehension (although patients who present with agrammatic production may not
necessarily have agrammatic comprehension).

An example of agrammatic speech:

 Ah ... Monday ... ah, Dad and Paul Haney [himself] and Dad ... hospital. Two .. .ah, doctors ... and ah
... thirty minutes .. .and yes ... ah ... hospital. And, er, Wednesday ... nine o'clock. And er Thursday,
ten o'clock .. .doctors. Two doctors ... and ah ... teeth. Yeah, ... fine.

Another example:

M.E. Cinderella...poor...um 'dopted her...scrubbed floor, um, tidy...poor, um...'dopted...Si-sisters and

mother...ball. Ball, prince um, shoe...

Examiner Keep going.

M.E. Scrubbed and uh washed and un...tidy, uh, sisters and mother, prince, no, prince, yes.
Cinderella hooked prince. (Laughs.) Um, um, shoes, um, twelve o'clock ball, finished.

Examiner So what happened in the end?

M.E. Married.

Examiner How does he find her?

M.E. Um, Prince, um, happen to, um...Prince, and Cinderalla meet, um met um met.

Examiner What happened at the ball? They didn't get married at the ball.

M.E.No, um, no...I don't know. Shoe, um found shoe...

Here is a more detailed picture of the motor strip, showing what is sometimes called the motor
homunculus, which is a depiction of how motor functions are localized along the motor strip. The portion
adjacent to Broca's area controls the face and mouth.

In between the motor strip and Broca's area are the areas known as the supplementary motor area
(SMA) and the premotor cortex, which are said to be involved in the generation of action
sequences from memory that fit into a precise timing plan All in all, it seems likely that Broca's area
is connected to serialization of coordinated action of the speech organs. Why do certain syntactic
abilities also seem to be localized there? Perhaps a neural architecture evolved for creating and
storing complex motor plans has been pressed into service to create and store symbolic rather
than purely motoric structures. As Deacon (1991) writes:
 Human language has effectively colonized an alien brain in the course of the last two million years.
Evolution makes do with what it has at hand. The structures which language recruited to its new
tasks came to serve under protest, so to speak. They were previously adapted for neural calculations
in different realms and just happened to exhibit enough overlap with the demands of language
processing so as to make "retraining" and "reorganization" minimally costly in terms of some as yet
unknown evolutionary accounting. Many of the structural peculiarities of language, its quasi-
universals, and the way that it is organized within the brain no doubt reflect this preexisting
scaffolding.

The second classical aphasic syndrome is named after the German neurologist Carl Wernicke (1848-1905).

Wernicke's aphasia is sometimes called sensory aphasia or fluent aphasia. The speech of a
Wernicke's patient is often a normally-intoned stream of grammatical markers, pronouns,
prepositions, articles and auxiliaries, with difficulty in recalling correct content words, especially
nouns (anomia). Words may be meaningless neologisms (paraphasia).

The patient in the passage below is trying to describe a picture of a child taking a cookie.

C.B. Uh, well this is the ... the /dodu/ of this. This and this and this and this. These things going in
there like that. This is /sen/ things here. This one here, these two things here. And the other one
here, back in this one, this one /gesh/ look at this one.

Examiner Yeah, what's happening there?

C.B. I can't tell you what that is, but I know what it is, but I don't now where it is. But I don't
know what's under. I know it's you couldn't say it's ... I couldn't say what it is. I couldn't say
what that is. This shu-- that should be right in here. That's very bad in there. Anyway, this
one here, and that, and that's it. This is the getting in here and that's the getting around here,
and that, and that's it. This is getting in here and that's the getting around here, this one and
one with this one. And this one, and that's it, isn't it? I don't know what else you'd want.

Wernicke's patients seem to suffer from much greater disorders of thought than Broca's patients, who often
seem able to reason much as before their stroke, but are simply unable to express themselves fluently.
However, their non-fluency causes them much frustration, and they are said to be unhappier than
Wernicke's patients, who are often blissfully unaware that nothing they say makes any sense at all, and
whose higher-level thinking processes are often as haphazard as their language is.

Wernicke's area is at the boundary of the temporal and parietal lobes, near the parietal lobe
association cortex, where cross-modality integration is said performed, and is adjacent to the
auditory association cortex in the temporal lobe. Thus Wenicke's aphasia is sometimes called a
"receptive" aphasia, by distinction with the "production" aphasia of the motor-system-related
Broca's syndrome. However, as the above examples indicate, Wernicke's patients show plenty of
problems in producing coherent discourse. Even if Wernicke's area originally served a receptive
function, it has been taken over by the linguistic system just as Broca's area has been.

To give you some sense of what the injuries involved in this aphasic syndromes are like, here is a
photo of the excised brain of a Wernicke's patient:

Here is a set of tomographic pictures of a different Wernicke's syndrome brain, showing a series of
horizontal slices. The front of the head is towards the top, and the dominant (left) side is on the
right, so it is as if we are looking at the brain from the bottom:

A more elaborated taxonomy

The table below shows the relationship of 8 named aphasic syndromes to six general types of
symptoms:

Right-side Sensory
Fluent Repetition Comprehension Naming
hemiplegia deficits

Broca no Poor good poor yes few

Wernicke yes Poor poor poor no some

Conduction yes Poor good poor no some

Global no Poor poor poor yes yes

Transcortical
no Good good poor some no
motor

Transcortical
yes Good poor poor some yes
sensory

Transcortical
no Good poor poor some yes
mixed

Anomia yes Good good poor no no

Conduction aphasia generally results from lesion of the white-matter pathways that connect
Wernicke's and Broca's areas, especially the arcuate fasciculus.

Global aphasia results from lesions to both Wernicke's and Broca's areas at once.

The motor and sensory variants of transcortical aphasia are produced by lesions in areas around
Broca's and Wernicke's areas, respectively.

There are other syndromes as well, such as "pure word deafness", in which the patient can speak
and write more or less normally, but is not able to perceive speech, even though other auditory
perception is intact.

In actual clinical diagnosis, more elaborate batteries of tests are commonly given in order to assess
language function in more detail, and the detailed locations of lesions can be found by MRI
imaging.

Connecting mind and brain? the declarative/procedural model

We began this lecture by stressing the apparent dissociation between the phenomena of "language
in the mind" and the phenomena of "language in the brain." We'll end it with a brief presentation of
an idea that ties the observations about brain localization of language to many other aspects of
brain function, and at the same time makes contact with some of the most basic distinctions in the
cognitive architecture of language. This idea has been proposed by Michael Ullman and his
collaborators, under the name of the "declarative/procedural model."

Others have proposed a distinction between declarative memories and procedural memories.
Declarative memory is memory for facts, like the color of a peach; procedural memory is memory
for skills, like riding a bicycle. The declarative memory system is specialized for learning and
processing arbitrarily-related information, and is based in temporal (and temporal/parietal) lobe
structures. The procedural memory system is specialized for non-conscious learning and control of
motor and cognitive skills, which involve chaining of events in time sequence, and is based in
frontal/basal-ganglia circuits. Building on this earlier distinction, Ullman proposes that what we think
of as lexical knowledge (the association of meaning and sound for morphemes, irregular wordforms
and fixed or idiomatic phrases) is crucially linked with the declarative, temporal-lobe system, while
what we think of as grammatical knowledge (productive methods for real-time sequencing of lexical
elements) is crucially linked to the procedural, frontal/basal-ganglia system.

Ullman argues that declarative and lexical memory both involve learning arbitrary
conceptual/semantic relations; that the knowledge involved is explicit, i.e. relatively accessible to
consciousness; and that they involve lateral/inferior temporal-lobe structures for already-
consolidated knowledge, and medial temporal-lobe structures for new knowledge. By contrast,
procedural and grammatical memory both involve coordination of procedures in real time and
computation of sequential structures;the knowledge involved in both tends to be implicit and
encapsulated, so that it is relatively inaccessible to consciousness examination and control; and
both involve frontal and basal ganglia structures in the dominant hemisphere.

We can see this as a detailed elaboration of the old observation that Wenicke's area is adjacent to
primary auditory cortex, in the direction of visual cortex and cross-modal association areas, while
Broca's area is adjacent to the portion of the motor strip that controls the vocal organs.
Thedeclarative/procedural model is supported by a wide variety of interesting, specific and
sometimes unexpected evidence, coming from psycholinguistic studies, developmental studies,
neurological cases, functional imaging studies and neurophysiological observations.

http://www.ling.upenn.edu/courses/Fall_2001/ling001/neurology.html

APHASIA
Aphasia - damage to brain tissue resulting in language loss
- caused by strokes, cerebral tumors and lesions, accidents
- 98% of cases involve damage to perisylvian area of left hemispheric cortex
- children much more likely to recover from aphasia
Aphasia studies suggest that the perisylvian area is subdivided into at least two smaller areas
with distinct functions: Broca's and Wernicke's Regions
Damage to the entire perisylvian area results in complete language loss
Damage to one or the other region causes two very different types of aphasia
Broca's Region - front portion of perisylvian area
Broca's Aphasia (Emissive, or Agrammatic Aphasia)
Named in 1861 after French doctor Paul Broca
Symptoms:
- great difficulty in speaking, but less difficulty in understanding.
- speech is labored, mainly consists of isolated content words
- grammatical, syntactic connectedness, function words and affixes lost.
- grammar is destroyed; the lexicon more or less preserved intact.
Wernicke's Region - back portion of perisylvian area
Wernicke's Aphasia (Receptive, or Jargon Aphasia)
Named in 1861 after German doctor Karl Wernicke
Symptoms:
- mirror opposite of Broca's aphasia
- patient blabs nonstop, uttering long-winded, grammatically fluent nonsense
- can't understand or respond to the content of questions
- grammar, syntax, function morphemes preserved
- content words mostly destroyed, uses substitutes like "whatchamacallit"
Broca's region apparently houses elements of language that have
specific function but no specific meaning:
syntactic rules, phonological patterns, function morphemes
that is, the grammatical glue which holds the context together.
Wernicke's region houses the elements of language that have
specific meaning: the content words, the lexemes,
the entire dictionary of ready-made meaningful elements (listemes)
which a speaker selects when filling in a context.
Do sub-areas of Broca's and Wernicke's region house
specific subcomponents of grammar or lexicon? Probably yes.
Implications of aphasia studies for understanding symbolic human behavior.
Semiotics - the study of the intentional use of signs (including language)
Roman Jakobson (Russian linguist) - connected aphasia with semiotics
All semiotic systems contain only two types of cognitive associations:
Contiguity Similarity/contrast
(real connectedness in time and space) (connectedness in imagination)
Metonymy, Synecdoche Metaphor, Simile
contiguous, but otherwise unlike concepts synonyms, antonyms, type
Examples: Examples:
KNIFE- fork, food, eat, meat, cut, blade dagger, sword, pin
WINE - drunk, tipsy, hangover, grapes champagne, drink, liquor
lost by Broca's aphasic lost by Wernicke's aphasic
CONTIGUITY DISORDER SIMILARITY DISORDER
SEMIOTIC STYLES AND TENDENCIES APPARENTLY DOMINATED BY
BROCA'S REGION WERNICKE'S REGION
prose poetry
documentary fiction
realism vs. romanticism
symbolism, surrealism
cubism vs. impressionism
contagious magic vs. sympathetic magic
Conclusions about the perisylvian area:
- involvement in communication unique to humans
- builds not only language, but all conscious symbolic behavior
- humans have inborn propensity for creative symbolic behavior
General conclusion:
 Keep studying linguistics!

Neurolinguistics

Neurolinguistics is the study of how language is represented in the brain: that is, how and where our brains
store our knowledge of the language (or languages) that we speak, understand, read, and write, what
happens in our brains as we acquire that knowledge, and what happens as we use it in our everyday lives.
Neurolinguists try to answer questions like these: What about our brains makes human language possible
why is our communication system so elaborate and so different from that of other animals? Does language
use the same kind of neural computation as other cognitive systems, such as music or mathematics? Where
in your brain is a word that you've learned? How does a word come to mind when you need it (and why
does it sometimes not come to you?)

If you know two languages, how do you switch between them and how do you keep them from interfering
with each other? If you learn two languages from birth, how is your brain different from the brain of someone
who speaks only one language, and why? Is the left side of your brain really the language side? If you lose
the ability to talk or to read because of a stroke or other brain injury, how well can you learn to talk again?
What kinds of therapy are known to help, and what new kinds of language therapy look promising? Do
people who read languages written from left to right (like English or Spanish) have language in a different
place from people who read languages written from right to left (like Hebrew and Arabic)? What about if you
read a language that is written using some other kind of symbols instead of an alphabet, like Chinese or
Japanese? If you're dyslexic, in what way is your brain different from the brain of someone who has no
trouble reading? How about if you stutter?

As you can see, neurolinguistics is deeply entwined with psycholinguistics, which is the study of the
language processing steps that are required for speaking and understanding words and sentences, learning
first and later languages, and also of language processing in disorders of speech, language, and reading.
Information about these disorders is available from the American Speech-Language Hearing Association
(ASHA), athttp://www.asha.org/public/.

How our brains work

Our brains store information in networks of brain cells (neurons and glial cells). These neural networks are
ultimately connected to the parts of the brain that control our movements (including those needed to produce
speech) and our internal and external sensations (sounds, sights, touch, and those that come from our own
movements). The connections within these networks may be strong or weak, and the information that a cell
sends out may increase the activity of some of its neighbors and inhibit the activity of others. Each time a
connection is used, it gets stronger. Densely connected neighborhoods of brain cells carry out computations
that are integrated with information coming from other neighborhoods, often involving feedback loops. Many
computations are carried out simultaneously (the brain is a massively parallel information processor).

Learning information or a skill happens by establishing new connections and/or changing the strengths of
existing connections. These local and long-distance networks of connected brain cells show
plasticity http://merzenich.positscience.com/?page_id=143 that is, they can keep changing throughout our
lives, allowing us to learn and to recover (to some extent) from brain injuries. For people with
aphasiahttp://www.asha.org/public/speech/disorders/Aphasia.htm (language loss due to brain damage),
depending on how serious the damage is, intense therapy and practice, perhaps in combination with
transcranial magnetic stimulation (TMS), may bring about major improvements in language as well as in
movement control; see the Aphasia section below, and the links posted there. Computer-based methods for
enabling such intense language practice under the supervision of a speech-language pathologist are
becoming available.

Where is language in the brain?

This question is hard to answer, because brain activity is like the activity of a huge city. A city is organized so
that people who live in it can get what they need to live on, but you can't say that a complex activity, like
manufacturing a product, is 'in' one place. Raw materials have to arrive at the right times, subcontractors are
needed, the product must be shipped out in various directions. It's the same with our brains. We can't say
that language is 'in' a particular part of the brain. It's not even true that a particular word is 'in' one place in a
person's brain; the information that comes together when we understand or say a word arrives from many
places, depending on what the word means. For example, when we understand or say a word like apple,
we are likely to use information about what apples look, feel, smell, and taste like, even though we arent
aware of doing this. So listening, understanding, talking, and reading involve activities in many parts of the
brain. However, some parts of the brain are more involved in language than other parts.

Most of the parts of your brain that are crucial for both spoken and written language are in the left side of the
cortex of your brain (the left hemisphere), regardless of what language you read and how it is written. We
know this because aphasia is almost always caused by left hemisphere injury, not by right hemisphere injury,
no matter what language you speak or read, or whether you can read at all. (This is true for about 95% of
right-handed people and about half of left-handed people.) A large part of the brain (the 'white matter')
consists of fibers that connect different areas to one another, because using language (and thinking)
requires the rapid integration of information that is stored and/or processed in many different brain regions.

Areas in the right side are essential for communicating effectively and for understanding the point of what
people are saying. If you are bilingual but didnt learn both languages from birth, your right hemisphere may
be somewhat more involved in your second language than it is in your first language. Our brains are
somewhat plastic that is, their organization depends on our experiences as well as on our genetic
endowment. For example, many of the auditory areas of the brain, which are involved with understanding
spoken language in people with normal hearing, are used in (visually) understanding signed language by
people who are deaf from birth or who became deaf early (and do not have cochlear implants). And blind
people use the visual areas of their brains in processing words written in Braille, even though Braille is read
by touch. http://www.scientificamerican.com/article.cfm?id=the-reading-region

Bilingual speakers develop special skills in controlling which language to use and whether it is appropriate
for them to mix their languages, depending on whom they are speaking to. These skills may be useful for
other tasks as well. http://www.nih.gov/researchmatters/may2012/05072012bilingual.htm

How neurolinguistic ideas have changed

Many established ideas about neurolinguistics in particular, roles of the traditional language areas
(Brocas area, Wernickes area) in the left hemisphere of the brain - have been challenged and in some
cases overturned by recent evidence. Probably the most important recent findings are 1) that extensive
networks involving areas remote from the traditional language areas are deeply involved in language use, 2)
that the language areas are also involved in the processing of non-language information, such as some
aspects of music http://www.youtube.com/watch?v=ZgKFeuzGEns, and 3) that the correlations of particular
areas of the brain with particular language impairments are much poorer than had been thought. This new
information has become available because of major improvements in our ability to see what is happening in
the brain when people speak or listen, and from the accumulation and analysis of many years of detailed
aphasia test data.

How neurolinguistic research has changed

For over a hundred years, research in neurolinguistics was almost completely dependent on the study of language comprehension and
production by people with aphasia. These studies of their language ability were augmented by relatively crude information about where the
injury was located in the brain. Neurologists had to deduce that information, such as it was, by considering what other abilities were lost, and
by autopsy information, which was not often available. A few patients who were about to undergo surgery to relieve severe epilepsy or tumors
could be studied by direct brain stimulation, when it was medically needed to guide the surgeon away from areas essential for the patients use
of language.

Early-generation computerized x-ray studies (CAT scans, CT scans) and radiographic cerebral blood-flow studies (angiograms) began to
augment experimental and observational studies of aphasia in the 1970s, but they gave very crude information about where the damaged part
of the brain was located. These early brain-imaging techniques could only see what parts of the brain had serious damage or restricted blood
flow. They could not give information about the actual activity that was taking place in the brain, so they could not follow what was happening
during language processing in normal or aphasic speakers. Studies of normal speakers in that period mostly looked at which side of the brain
was most involved in processing written or spoken language, because this information could be gotten from laboratory tasks involving reading
or listening under difficult conditions, such as listening to different kinds of information presented to the two ears at the same time (dichotic
listening).
Since the 1990s, there has been an enormous shift in the field of neurolinguistics. With modern technology, researchers can study how the
brains of normal speakers process language, and how a damaged brain processes and compensates for injury. This new technology allows
us to track the brain activity that is going on while people are reading, listening, and speaking, and also to get very fine spatial resolution of the
location of damaged areas of the brain. Fine spatial resolution comes from magnetic resonance imaging (MRI), which gives exquisite pictures
showing which brain areas are damaged; the resolution of CT scans has also improved immensely. Tracking the brains ongoing activity can
be done in several ways. For some purposes, the best method is detecting the electrical and magnetic signals that neurons send to one
another by using sensors outside the skull (functional magnetic resonance imaging, fMRI; electro-enecephalography, EEG;
magnetoencephalography, MEG; and event-related potentials, ERP). Another method is observing the event-related optical signal, EROS; this
involves detecting rapid changes in the way that neural tissue scatters infra-red light, which can penetrate the skull and see about an inch into
the brain. A third family of methods involves tracking the changes in the flow of blood to different areas in the brain by looking at oxygen
concentrations (BOLD) or at changes the way in which the blood absorbs near-infrared light (near-infrared spectroscopy, NIRS). Brain activity
can also be changed temporarily by transcranial magnetic stimulation (stimulation from outside the skull, TMS), so researchers can see the
effects of this stimulation on how well people speak, read, and understand language. NIRS, EROS, ERP, and EEG techniques are risk-free, so
they can ethically be used for research on normal speakers, as well as on people with aphasia who would not particularly benefit by being in a
research study. TMS also appears to be safe.

It is very complicated to figure out the details of how the information from different parts of the brain might combine in real time, so another
kind of advance has come from the development of ways to use computers to simulate parts of what the brain might be doing during speaking
or reading.

Investigations of exactly what people with aphasia and other language disorders can and cannot do also continue to contribute to our
understanding of the relationships between brain and language. For example, comparing how people with aphasia perform on tests of syntax,
combined with detailed imaging of their brains, has shown that there are important individual differences in the parts of the brain involved in
using grammar. Also, comparing people with aphasia across languages shows that the various types of aphasia have somewhat different
symptoms in different languages, depending on the kinds of opportunities for error that each language provides. For example, in languages
that have different forms for masculine and feminine pronouns or masculine and feminine adjectives, people with aphasia may make gender
errors in speaking, but in languages that dont have different forms for different genders, that particular problem cant show up.

by: Lise Menn

http://www.linguisticsociety.org/resource/neurolinguistics

Psycholinguistics/Aphasia

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Introduction[edit]

Aphasia is a language disorder caused by damage suffered to certain portions of the brain that are involved in language perception and
production. Depending upon the area that is affected, a person suffering from Aphasia may be able to speak fluently but not coherently, and
vice versa. Aphasiology is the study of these linguistic deficits resulting from brain damage and through this study, much can be learned and
inferred about the normal function of language and its organization within the brain. There are a variety of modern assessment tools through
which aphasia can be studied in patients. The prognosis varies greatly and is dependent upon such factors as, site of the stroke, severity of
the lesion, the age of the patient, and the type of aphasia acquired.
History[edit]

The word Aphasia is derived from the Greek word aphatos, meaning speechless. [1] Mentions of Aphasia in Greek Medicine are evident in
which speechlessness accompanied convulsions are documented as resulting in paralysis of the right side of the body. Aphasia is again
shown in literature from the Roman times in which authors such as Soranus of Ephesus noted the impairment of speech following paralysis of
one part of the body. [1] Great advancements occurred from the 1800s to the 1860s in which clinical knowledge, theoretical formulation and
neuropathology were developed and a working knowledge of the brain as associated with speech disorders was beginning to be understood
more scientifically.

The most recent widespread acceptance of the brain's functioning is in the language localization theory in which different sections of the brain
are responsible for the functioning of different bodily functions. The birth of this concept came with Franz Joseph Gall's theory of phrenology.
Gall proposed that all mental functioning could be located on different sections of the brain and the advancement of a particular area resulted
in a visible difference on a person's head. Although Franz Gall's theory of phrenology is now considered a pseudoscience, his localizationist
assumptions were evidently working in the right direction as it is now possible to scientifically prove that certain sections of the brain are
involved in different bodily functions. [2]

The theory of language localization gained furthur credit with significant findings attributed to Paul Broca in the 1860s. [2] The beginning of
comprehensive Aphasia understanding came with Paul Brocas research and subsequent description of his patient Laborgne's brain. In 1861,
Broca published Remarques sur le sige de la facult du langage articul: suivies d' une observation d'aphmie in which he evidences for
the localization of articulate speech in the frontal lobe. [1] Upon Leborgnes death, Broca performed an autopsy and determined that the
damage was suffered to the third convolution of the left frontal lobe, which is now commonly referred to as Brocas area. [2] Stemming from his
influential findings, was a revolution in medical and physioogical thinking as it pertained to the brain and the establishment of cerebral
localization. Less than a decade later, Wernicke identified sensory aphasia as being localized to the temporal lobe. [1] Ludwig Lichtheim then
branched off of Wernickes model, naming five other types of aphasia, pure word deafness, conduction aphasia, apraxia of speech,
transcortical motor aphasia, and transcortical sensory aphasia.
As the mid 20th century approached, professionals specializing in language began searching for a revised model of understanding normal and
abnormal language functioning. One professional by the name of Norman Geschwind formed the Geschwind model. Revisiting language
localization theories, the model describes the interconnecting functions of a normally working human brain to produce speech and language
comprehension. Aphasias were viewed as occurring along these interconnecting lines, disrupting spoken speech or comprehension, resulting
in various symptoms. [1] Although the Geschwind model was a great contribution to the understanding of language, problems with it have been
uncovered in recent years and a straying away from this understanding of language functioning has occurred. [3]

Advancements in imaging technology has propelled our understanding of the brain as it pertains to language and disorders such as
aphasia.Voxel-based Lesion Symptom Mapping (VLSM) in particular, has allowed for medical professionals to determine more specifically
where brain lesions lie and the tasks that are impaired because of them. VLSM's ability to identify white matter regions which can play causal
roles in certain cognitive domains allows for professionals closely identify these problem regions. A 'voxel' is the three dimensional analog of a
pixel and represents a volume of 1 cubic millimeter; The image produced displays 3 dimensional picture of the human brain as depicted in the
picture to the right. Studies using VSLM have suggested that language functions are not as localized as the Geschwind model posits it to be. [4]

Forms of Aphasia[edit]

Aphasia can be divided into three category types depending upon the quality of the deficit acquired. Fluent, non-fluent, and pure:

Fluent
Fluent aphasias are caused by impairment to language reception. These aphasic individuals have little issue with fluent verbal
output but have difficulty in the language that they are speaking, which often seems like nonsense. Some fluent aphasias include:
Wernickes Aphasia, Conduction Aphasia, and Anomic Aphasia. [5]

Non-fluent
Non-fluent aphasias are impaired in their ability to articulate. Unlike some fluent aphasias, non-fluent aphasics retain a relatively
intake auditory verbal comprehension. Some examples of non-fluent aphasias include: Brocas aphasia, Transcortical motor
aphasia, and global aphasia. [5]

Pure-Aphasia
Pure aphasias display themselves as selective deficits to writing, reading or the recognition of words altogether. Pure aphasias
include: Pure alexia, Pure word deafness, and Agraphia. [5]

Types of Aphasia[edit]
Broca's Aphasia[edit]
Broca's aphasia, also referred to as 'expressive aphasia, occurs as a result of damage to the frontal lobe of the brain. As a result of
the deletion of function words (i.e. 'and', 'the'), speech by a Broca's aphasic appears telegraphically. As opposed to wernicke's
aphasia, speech is nonfluent, and highly laboured depending upon the severity of the aphasia. [1]
 Global Aphasia[edit]
This type of aphasia is a result of extensive damage to the language areas of the brain with the impairments appearing globally
across all areas of speech processing and production. [1]
Transcortical Motor Aphasia (TMA)[edit]
Patients with TMA, also referred to as adynamic aphasia, display nonfluent speech as well as phonemic and global paraphasias and
the omission of function words. This aphasia results from damage, typically caused by a stroke, of the anterior superior frontal
lobe. [1]
Wernicke's Aphasia[edit]
Wernickes Aphasia occurs as a result of damage to the temporal lobe of the brain. Patients exhibit fluent speech and paraphasias
and in some types are unable to comprehend speech as well as produce comprehensible speech. [1]
Conduction Aphasia[edit]
Conduction aphasia, also referred to as 'associative aphasia', is a fluent disorder caused by damage to the left hemisphere of the
brain above and below the posterior sylvian fissure. Auditory comprehension remains fairly intact in these individuals, with speech
production being mostly affected. Speech repetition is poor, and spontaneous speech production is laboured, with frequent
substitution of words or transposing of sounds. As opposed to wernicke's aphasia, patients with conduction aphasia are often aware
of their mistakes and make efforts at correcting their errors. [6] [1]
Anomic Aphasia[edit]
Anomic aphasia occurs as a result of damage to the language areas outside the perisylvian circle. Characteristic of this aphasia is
difficulty in word retrieval, while fluent and well-articulated speech remains intact. [1]
Transcortical Sensory Aphasia (TSA)[edit]
[6]
TSA patients display damage to the temporal occipital parietal junction located behind Wernicke's area.

TSA differs from Wernicke's aphasia in that, although they are both fluent disorders,
TSA sufferers have fluent and usually comprehensible speech, save for semantic
paraphasia in which similar words are substituted for an item. Auditory comprehension
is often severely impaired. [1]

The following table separates the different types of aphasias, identifies the area of
the brain affected and then names the deficits incurred by each.

Spontaneous Speech
Disorder Site of Lesion
Speech Comprehension

Left frontal cortex rostral

Brocas aphasia Nonfluent Relatively intact
to base of motor cortex

Anterior and posterior

Global aphasia Nonfluent Poor
language areas

Transcortical Areas anterior and

Nonfluent Relatively intact
motor aphasia superior to Brocas areas

Posterior part of the

Wernickes superior and middle left
Fluent Poor
aphasia temporal gyrus and left
temporoparietal cortex
 Temporoparietal region,
Conduction
above and below Fluent Relatively intact
Aphasia
posterior Sylvian fissure

Posterior part of the

superior and middle left
Anomic Aphasia Fluent Relatively intact
temporal gyrus and left
temporoparietal

Posterior to Wernickes
Transcortical
area around boundary of Fluent Poor
sensory aphasia
occipital lobe

[3]
(From Biological Psychology by Klein, Stephen B., 2000.)

Signs and Symptoms[edit]

Individuals may experience one or many of the following symptoms of an acquired

aphasia due to stroke or brain damage:

Disturbances in Naming 'Paraphasia' :

Paraphasia refers to the inability to use correct words in speech through substitution of
other words in a way that makes speech incomprehensible. In normal human speech,
the ability to quickly retrieve words from a mental lexicon makes it easy for speech to
sound fluid, well- structured and effortless. This process of selecting a word, termed
word finding, is automatic for most of the population of normal speakers, but for
aphasics displaying paraphasia, this process is greatly impaired resulting in the
substitution of random words for the intended word. It is called global aphasia when an
aphasic substitutes an entire word and semantic aphasia when a word belonging to the
same semantic field is substituted. [1]

Disturbance of Fluency:

Aphasic patients are grouped into two categories: fluent, and non-fluent. Fluent
aphasics retain the ability to speak in continuous strains of words, with the meaning of
the uttered words being the point of issue. Non-fluent aphasics, such as Brocas
aphasics, suffer from low speech rate, short sentence length, with the production of
sentences, and even single words being laboured. [1]

Disturbance of Repetition:

In some aphasia patients, the ability to repeat words may be lost. More specifically,
impairment of the ability to repeat indicates that the damage to the brain is located in
the perisylvian region of the dominant hemisphere. Conversely, patients suffering from
transcortical aphasia repeat too frequently, and engage in a echolalia, meaning they
repeat what is being said to them without knowledge that they are doing so. [1]

Disturbance of Grammatical Processing 'Agrammatism' :

Agrammatism refer to an aphasics inability to speak correctly in terms of grammatical

morphemes. As a result of this, free grammatical morphemes, as well as inflectional
affixes which indicate tense or aspect, are not present in speech. Sentences are
oversimplified with the omission of these function words, resulting in a telegraphic
speech. Also, these patients have difficulty with questions or complex sentence, such as
passive sentences. The severity of the aphasia predicts the amount of errors an aphasic
makes in this area.[1]

Disturbances of Reading and Writing:

Certain Aphasias can affect reading and/or writing as well as speech production and
processing. Reading and writing are not necessarily affected together or even equally
when the pairing does occur, however, in some aphasias, all of the above are affected
together, only in varying degrees of intensity. [1]

Apraxia of Speech:

This type of Apraxia, also referred to as dyspraxia, occurs when the brain is damaged in
a way that disrupts voluntary movement involved in speech production. When patients
with Apraxia are asked to perform a physical command, they are unable to do so even
though the command is understood and the speech muscles are not impaired due to
paralysis. Two types of Apraxia exist: Acquired Apraxia of Speech, and Developmental
Apraxia of Speech. The focus, as it related to Aphasia, is in acquired apraxia of speech
as it is a result of sustaining injury to the central nervous system. [1]

Treatments[edit]

Aphasia Rehabilitation

Learning Exercise[edit]

1. The following youtube clips show different situations in which people suffer from
aphasia. During the first segment, you encounter councilman Ken Albrecht. Given the
way he speaks during therapy, what type of Aphasia does he likely have? As well,
referring back to the table on the types of aphasia, what type of Aphasia does the man
in the second clip suffer from?

http://www.youtube.com/watch?v=Bk13HLma2CI

http://www.youtube.com/watch?v=ZDbSh5DoVJA&feature=related

2.Refer back to the readings of this chapter. What is the primary issue with the
Geschwind model?
 3.Watch the following video: http://www.youtube.com/watch?v=NUTpel04Nkc

What qualities of Brocas aphasia does Charles display?

Why is it that he has such an issue with the simple sentence concerning the leopard and the lion?

What types of symptoms would you be witnessing if Charles was suffering from Conduction Aphasia?

4. What does the study of Aphasias tell us about the brain and language?

5. What recent advancements have made it possible to study the brain in detail?

6. As a doctor you encounter a patient who begins to describe experiencing what

you suspect to be a stroke. Upon studying their behaviour, you come to find that
their fluency of speech is normal, but their ability to name things is greatly impaired
and proves to be laboured and frustrating for the patient. What type of aphasia has
this patient experienced? What part of the brain was likely damaged due to the
stroke?

7. If the temporoparietal region of the brain is damaged, what type of aphasia is a

patient suffering from and what would their symptoms be?

References[edit]

1. Jump up
to:1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17
Damasio, A.
R. (1998). Signs of aphasia. In M. T. Sarno (Ed.), Acquired aphasia (3rd
ed.). (pp. 25-41). San Diego, CA US: Academic Press.
doi:10.1016/B978-012619322-0/50005-1

2. Jump up to:2.0 2.1 2.2 Nadeau, S. E. (. )., Gonzalez Rothi, Leslie Janine (Ed.),
& Crosson, B. (. ). (2000). In Crosson B. (Ed.), Aphasia and lanaguage:
Theory to practice. New York, NY US: Guilford Press.

3. Jump up to:3.0 3.1 Jay, Timothy B. (2003). The Psychology of Language.

Upper Saddle River, New Jersey US: Prentice Hall.

4. Jump up Piras, F., & Marangolo, P. (2007). Noun-verb naming in

aphasia: A voxel-based lesion-symptom mapping study. NeuroReport:
For Rapid Communication of Neuroscience Research, 18(14), 1455-
1458. doi:10.1097/WNR.0b013e3282ef6fc9

5. Jump up to:5.0 5.1 5.2 Tesak, J., & Code, C. (2008). Milestones in the history
of aphasia: Theories and protagonists. New York, NY US: Psychology
Press.

6. Jump up to:6.0 6.1 http://www.nidcd.nih.gov/health/voice/aphasia.html

https://en.wikiversity.org/wiki/Psycholinguistics/Aphasia

I once had a patient who suffered a right hemisphere stroke and fell to the
ground, unable towalk because of a paralyzed left leg. She lay on the floor for
two days, not because no one came to her aid, but because she kept blithely
reassuring her husband that she was fine, that there was nothing wrong with her
leg. Only on the third day did he bring her in for treatment.
When I asked her why she could not move her left leg, and held it up for her to
see, she said indifferently that it was someone elses leg. Flaherty (2004)
In the preceding chapters we have reviewed in some detail the various features
of language that people use to produce and understand linguistic messages.
Where is this ability to use language located? The obvious answer is in the
brain. However, it cant be just anywhere inthe brain. For example, it cant be
where damage was done to the right hemisphere of thepatients brain in Alice
Flahertys description. The woman could no longer recognize her ownleg, but she
could still talk about it. The ability to talk was unimpaired and hence clearly
located somewhere else in her brain.
Neurolinguistics
The study of the relationship between language and the brain is called
neurolinguistics.
Although this is a relatively recent term, the field of study dates back to the
nineteenth century. Establishing the location of language in the brain was an
early challenge, but one event incidentally provided a clue.
In September 1848, near Cavendish, Vermont, a construction foreman called
Phineas P. Gage was in charge of a construction crew blasting away rocks to lay
a new stretch of railway line. As Mr. Gage pushed an iron tamping rod into the
blasting hole in a rock, some gunpowder accidentally exploded and sent the
three-and-a-halffoot long tamping rod up through his upper left cheek and out
from the top of his forehead. The rod landed about fifty yards away. Mr. Gage
suffered the type of injury from which, it was assumed, no one could recover.
However, a month later, he was up and about, with no apparent damage to his
senses or his speech.
The medical evidence was clear. A huge metal rod had gone through the front
part ofMr. Gages brain, but his language abilities were unaffected. He was a
medical marvel.
The point of this rather amazing tale is that, while language may be located in the
brain, it clearly is not situated right at the front.
Language areas in the brain
Since that time, a number of discoveries have been made about the specific
parts inthe brain that are related to language functions. We now know that the
mostimportant parts are in areas above the left ear. In order to describe them in
greaterdetail, we need to look more closely at some of the gray matter. So, take a
head,remove hair, scalp, skull, then disconnect the brain stem (connecting the
brain to the spinal cord) and cut the corpus callosum (connecting the two
hemispheres). If we disregard a certain amount of other material, we will
basically be left with two parts, the left hemisphere and the right hemisphere. If
we put the right hemisphere aside for now, and place the left hemisphere down
so that we have a side view, well be looking at something close to the
accompanying illustration (adapted from Geschwind, 1991).
The shaded areas in this illustration indicate the general locations of those
language functions involved in speaking and listening. We have come to know
that these areas exist largely through the examination, in autopsies, of the brains
of people who, in life, were known to have specific language disabilities. That is,
we have tried to determine where language abilities for normal users must be by
finding areas with specific damage in the brains of people who had identifiable
language disabilities.
Brocas area
The part shown as (1) in the illustration is technically described as the anterior
speech cortex or, more usually, as Brocas area. Paul Broca, a French surgeon,
reported in the 1860s that damage to this specific part of the brain was related to
extreme difficulty in producing speech. It was noted that damage to the
corresponding area on the right hemisphere had no such effect. This finding was
first used to argue that language ability must be located in the left hemisphere
and since then has been treated as an indication that Brocas area is crucially
involved in the production of speech.
Wernickes area
The part shown as (2) in the illustration is the posterior speech cortex, or
Wernickes area. Carl Wernicke was a German doctor who, in the 1870s,
reported that damage to this part of the brain was found among patients who had
speech comprehension difficulties. This finding confirmed the left hemisphere
location of language ability and led to the view that Wernickes area is part of the
brain crucially involved in the understanding of speech.
The motor cortex and the arcuate fasciculus
The part shown as (3) in the illustration is the motor cortex, an area that generally
controls movement of the muscles (for moving hands, feet, arms, etc.). Close to
Brocas area is the part of the motor cortex that controls the articulatory muscles
of the face, jaw, tongue and larynx. Evidence that this area is involved in the
physical articulation of speech comes from work reported in the 1950s by two
neurosurgeons, Penfield and Roberts (1959). These researchers found that, by
applying small amounts of electrical current to specific areas of the brain, they
could identify those areas where the electrical stimulation would interfere with
normal speech production.
The part shown as (4) in the illustration is a bundle of nerve fibers called the
arcuate fasciculus. This was also one of Wernickes discoveries and is now
known to form a crucial connection between Wernickes and Brocas areas.
The localization view
Having identified these four components, it is tempting to conclude that specific
aspects of language ability can be accorded specific locations in the brain. This is
called the localization view and it has been used to suggest that the brain activity
involved in hearing a word, understanding it, then saying it, would follow a
definite pattern. The word is heard and comprehended via Wernickes area. This
signal is then transferred via the arcuate fasciculus to Brocas area where
preparations are made to produce it. A signal is then sent to part of the motor
cortex to physically articulate the word.
This is certainly an oversimplified version of what may actually take place, but it
is consistent with much of what we understand about simple language
processing in the brain. It is probably best to think of any proposal concerning
processing pathways in the brain as some form of metaphor that may turn out to
be inadequate once we learn more about how the brain functions. The pathway
metaphor seems quite appealing in an electronic age when were familiar with
the process of sending signals through electrical circuits. In an earlier age,
dominated more by mechanical technology, Sigmund Freud subtly employed a
steam engine metaphor to account for aspects of the brains activity when he
wrote of the effects of repression building up pressure to the point of sudden
release. In an even earlier age, Aristotles metaphor was of the brain as a cold
sponge that functioned to keep the blood cool.
In a sense, we are forced to use metaphors mainly because we cannot obtain
direct physical evidence of linguistic processes in the brain. Because we have no
direct access, we generally have to rely on what we can discover through indirect
methods.
Most of these methods involve attempts to work out how the system is working
from clues picked up when the system has problems or malfunctions.
Aphasia
If you have experienced any of those slips on occasion, then you will have
some hint of the types of experience that some people live with constantly. Those
people suffer from different types of language disorders, generally described as
aphasia.
Aphasia is defined as an impairment of language function due to localized brain
damage that leads to difficulty in understanding and/or producing linguistic forms.
The most common cause of aphasia is a stroke (when a blood vessel in the brain
is blocked or bursts), though traumatic head injuries from violence or an accident
may have similar effects. Those effects can range from mild to severe reduction
in the ability to use language. Someone who is aphasic often has interrelated
language disorders, in that difficulties in understanding can lead to difficulties in
production, for example.
Consequently, the classification of different types of aphasia is usually based on
the primary symptoms of someone having difficulties with language.
Brocas aphasia
The serious language disorder known as Brocas aphasia (also called motor
aphasia) is characterized by a substantially reduced amount of speech, distorted
articulation and slow, often effortful speech. What is said often consists almost
entirely of lexical morphemes (e.g. nouns, verbs). The frequent omission of
functional morphemes (e.g. articles, prepositions) and inflections (e.g. plural -s,
past tense -ed) has led to the characterization of this type of aphasic speech as
agrammatic. In agrammatic speech, the grammatical markers are missing.
An example of speech produced by someone whose aphasia was not severe is
the following answer to a question regarding what the speaker had for breakfast:
I eggs and eat and drink coffee breakfast
However, this type of disorder can be quite severe and result in speech with lots
of hesitations and really long pauses (marked by ): my cheek very
annoyance main is my shoulder achin all round here. Some patients can
also have lots of difficulty in articulating single words, as in this attempt to say
steamship: a stail you know what I mean tal stail. In Brocas aphasia,
comprehension is typically much better than production.
Wernickes aphasia
The type of language disorder that results in difficulties in auditory
comprehension is sometimes called sensory aphasia, but is more commonly
known as Wernickes aphasia. Someone suffering from this disorder can actually
produce very fluent speech which is, however, often difficult to make sense of.
Very general terms are used, even in response to specific requests for
information, as in this sample: I cant talk all of the things I do, and part of the part
I can go alright, but I cant tell from the other people.
Difficulty in finding the correct word, sometimes referred to as anomia, also
happens in Wernickes aphasia. To overcome their word-finding difficulties,
speakers use different strategies such as trying to describe objects or talking
about their purpose, as in the thing to put cigarettes in (for ashtray). In the
following example (from Lesser & Milroy, 1993), the speaker tries a range of
strategies when he cant come up with the word (kite) for an object in a picture.
its blowing, on the right, and er theres four letters in it, and I think it begins with a
C goes when you start it then goes right up in the air I would I would have
to keep racking my brain how I would spell that word that flies, that that doesnt
fly, you pull it round, it goes up in the air
Conduction aphasia
One other, much less common, type of aphasia has been associated with
damage to the arcuate fasciculus and is called conduction aphasia. Individuals
suffering from this disorder sometimes mispronounce words, but typically do not
have articulation problems.
They are fluent, but may have disrupted rhythm because of pauses and
hesitations.
Comprehension of spoken words is normally good. However, the task of
repeating a word or phrase (spoken by someone else) creates major difficulty,
with forms such as vaysse and fosh being reported as attempted repetitions of
the words base and wash. What the speaker hears and understands cant be
transferred very successfully to the speech production area.
It should be emphasized that many of these symptoms (e.g. word-finding
difficulty) can occur in all types of aphasia. They can also occur in more general
disorders resulting from brain disease, as in dementia and Alzheimers disease.
Difficulties in speaking can also be accompanied by difficulties in writing.
Impairment of auditory comprehension tends to be accompanied by reading
difficulties.
Language disorders of the type we have described are almost always the result
of injury to the left hemisphere. This left hemisphere dominance for language has

also been demonstrated by another approach to the investigation of language

and the brain.